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Background: The impact of timing of PORT initiation for major salivary gland cancers on survival is unknown. We aim to examine the impact of PORT timeliness on overall survival (OS) of patients with major salivary gland cancers., Methods: This was a cross-sectional analysis using data from the National Cancer Database (2004-2017) and included patients with major salivary gland cancer treated with surgery and PORT., Results: In total, 5701 patients were included (3133 [55%] male, 4644 [82%] white, mean age 59 ± 16 years). For the overall cohort, PORT >6 weeks was not associated with decreased OS (1.00 aHR, 95% CI 0.89-1.11). When specifically examining patients with mucoepidermoid carcinoma, PORT >6 weeks was associated with a decreased OS (1.27 aHR, 95% CI 1.01-1.58)., Conclusions: Overall, this analysis did not demonstrate a survival benefit for initiating PORT within 6 weeks for patients with salivary gland malignancies. Subset analysis did support initiating PORT within 6 weeks after resection for patients with mucoepidermoid carcinomas. This was not demonstrated in other major salivary gland cancer histologies., (© 2024 The Author(s). Head & Neck published by Wiley Periodicals LLC.)

Objective: To investigate the effectiveness of radiotherapy and its association with second primary malignancies (SPMs) risk in major salivary gland carcinomas (MSGCs) patients., Methods: Cohort 1 included 7274 surgically treated MSGC patients from the Surveillance, Epidemiology, and End Results database, assessing the effectiveness of radiotherapy. Cohort 2 (n = 4213) comprised patients with ≥5-year survival in Cohort 1 to study SPMs., Results: Radiotherapy decreased overall survival in MSGCs patients, but improved it in high-grade MSGCs. Cumulative SPMs incidences at 25 years were 16.5% in the radiotherapy (RT) group compared to 14.5% in the non-radiotherapy (NRT) group. For second head and neck carcinomas (SHNCs), incidences were 3.4% in RT versus 1.6% in NRT. Radiotherapy increased the relative risks of tumors, particularly SHNCs (RR = 1.78). The 10-year OS rates of SHNCs after radiotherapy were significantly lower., Conclusion: Radiotherapy improves survival in advanced-stage MSGCs but increases the risk of developing SPMs, particularly SHNCs., (© 2024 Wiley Periodicals LLC.)

Background: This study investigated the effects of adjuvant radiotherapy on outcomes in early-stage major salivary gland cancers., Methods: A total of 655 patients were identified, including 355 (54.2%) received adjuvant radiotherapy and 300 (45.8%) had surgery alone. The effect of adjuvant radiotherapy on 5-year locoregional recurrence and disease-specific survival (DSS) was calculated using the Kaplan-Meier method, Wilcoxon rank sum test, and Cox proportional hazards model., Results: There were no significant differences in locoregional recurrence and DSS between patients receiving adjuvant radiotherapy and those not in both univariate and multivariable analysis. Although patients with positive margin status had a higher locoregional recurrence and those with moderate/poor differentiation had a worse DSS, stratified analysis still indicated there were no protective effects from the use of adjuvant radiotherapy., Conclusions: The use of adjuvant radiation therapy was not associated with improved locoregional recurrence and DSS, even for those with high-risk histopathological factors., (© 2022 Wiley Periodicals LLC.)

Background: To evaluate the predicting factors associated with distant metastasis (DM) for lymphoepithelial carcinoma of salivary gland (LECSG) following postoperative radiotherapy (PORT)., Methods: We retrospectively collected 160 eligible patients from two cancer institutions. The DM rate was evaluated using competing risk method., Results: The median follow-up time was 65.6 months. Elevated preradiotherapy serum LDH (ratio >0.5) (p = 0.006) and N classification (N2-3) (p = 0.001) were independently associated with DM for the LECSG. After the risk stratification, the high-risk subgroup was defined as the patients presented higher risk score (score >0), whereas 5-year cumulative incidence of DM in the high- and low-risk group was 30.9% and 6.0%, respectively (p < 0.001). Moreover, a significantly worse overall survival (OS) was observed in the high-risk patients compared with the low-risk subgroup (5-year OS: 83.9% vs. 97.8%, p = 0.006)., Conclusion: Elevated preradiotherapy serum LDH could serve as a predictive factor for DM in the LECSG following PORT., (© 2022 Wiley Periodicals LLC.)

Background: Proton beam radiation therapy (PBRT) has dosimetric advantages compared to photon radiation therapy for the treatment of major salivary gland tumors (MSGTs)., Methods: Patients with non-metastatic MSGTs treated at a single proton therapy center from October 2013 to October 2018 were retrospectively reviewed., Results: Sixty-eight patients with MSGTs were included and the most common site and histology were the parotid gland (75.0%) and adenoid cystic carcinoma (22.1%), respectively. The 3-year rates of locoregional control, progression-free survival, and overall survival were 95.1% (95% CI: 89.9%-100.0%), 80.7% (70.2%-92.7%), and 96.1% (95% CI: 90.9%-100.0%), respectively., Conclusion: In a large cohort of MSGTs treated with PBRT, the rates of locoregional control were high in short-term follow-up and treatment was well tolerated., (© 2021 Wiley Periodicals LLC.)

Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend considering postoperative radiotherapy (PORT) for completely resected T1/2N0M0 salivary mucoepidermoid carcinomas when they show tumor spillage, perineural invasion, or intermediate/high-grade histology. CRTC1/3-MAML2 fusions have been associated with a favorable clinical outcome., Methods: Forty-seven T1/2N0M0 mucoepidermoid carcinoma cases positive for CRTC1/3-MAML2 fusions were completely resected and were not treated with PORT., Results: Pathologically, none of the cases showed tumor spillage or perineural invasion. Cases with intermediate/high-grade histology numbered 9 (19%) to 26 (55%) with the currently used 3 different grading systems. During the follow-up (median 60 months), locoregional tumor recurrence occurred in 4 cases, which were treated with surgery alone. At the last follow-up (median 60 months; 7-160), all patients were alive with no evidence of disease., Conclusion: An excellent prognosis may be achieved without PORT in T1/2N0M0 mucoepidermoid carcinoma patients positive for CRTC1/3-MAML2 fusions when the tumors are completely resected without tumor spillage., (© 2018 Wiley Periodicals, Inc.)

Background: The purpose of this study was to present our preliminary exploration of safety and efficacy of postoperative low-dose-rate brachytherapy for the early clinical stages of minor salivary gland carcinomas of the lip and buccal mucosa., Methods: Twenty-seven patients with the early stages of minor salivary gland carcinomas of the lip and buccal mucosa received postoperative 125 I seed interstitial brachytherapy from March 2005 to May 2015. Actuarial likelihood estimates for local control, overall survival, and disease-free survival were calculated by Kaplan-Meier method., Results: The actuarial 3-year, 5-year, and 10-year local control rates were 94.7%, 82.9%, and 82.9%, respectively. The actuarial 3-year, 5-year, and 10-year overall survival rates were 93.3%, 93.3%, and 77.8%, respectively. No patient experienced toxicity above grade 2., Conclusion: Postoperative 125 I seed interstitial brachytherapy is an alternative to radical surgery for early stages of minor salivary gland carcinomas of the lip and buccal mucosa, which offers satisfactory cosmetic and functional outcomes. © 2017 Wiley Periodicals, Inc. Head Neck 39: 572-577, 2017., (© 2017 Wiley Periodicals, Inc.)

Background: Malignant salivary gland neoplasms are rare in children. The purpose of this study was to present our experience in the treatment of primary and recurrent salivary gland neoplasm and contribute to the fractional available data., Methods: All patients <18 years, treated between June 2005 and April 2014 were included in this study., Results: The parotid gland was the most common site for both primary (n = 18) and recurrent (n = 6) tumors and mucoepidermoid carcinoma, low or intermediate grade, main histological type. Surgical excision was performed in all patients, of which 13 patients received radiotherapy. Lymph node metastasis was present in 3 patients with primary tumor, which were assessed accurately on frozen section examination. Local recurrence occurred in 1 patient with primary tumor and all patients are alive., Conclusion: Surgery is the prime modality of treatment for malignant salivary gland neoplasm and is associated with excellent outcomes. The role of lymph node sampling and frozen section examination needs further evaluation in identifying lymph node metastasis. © 2015 Wiley Periodicals, Inc. Head Neck 38: 852-856, 2016., (© 2015 Wiley Periodicals, Inc.)

Background: The majority of patients with locally advanced salivary gland carcinoma will die of the disease even after curative surgery. Few studies on adjuvant therapy have been conducted. In this study, we compared adjuvant chemoradiotherapy (CRT) with adjuvant radiotherapy among the older patient population., Methods: Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992-2009) was analyzed. Eligible cases were those receiving curative surgery followed by adjuvant therapy. Outcomes were overall survival and toxicity., Results: Analyses included 741 patients: 641 patients (86.5%) received adjuvant radiotherapy and 100 (13.5%) received adjuvant CRT. The median overall survival was 41.0 months with adjuvant radiotherapy and 24 months with CRT. Both multivariable and propensity score-adjusted analyses indicated that adjuvant CRT was associated with an increased mortality (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.07-1.79 and HR: 1.49; 95% CI: 1.14-1.94, respectively). Toxicity rates were significantly higher in the CRT group., Conclusion: Treatment with adjuvant CRT was associated with an increased mortality and toxicity when compared to adjuvant radiotherapy alone. © 2015 Wiley Periodicals, Inc. Head Neck 38: 863-870, 2016., (© 2015 Wiley Periodicals, Inc.)

Background: The survival rates and prognostic factors for salivary duct carcinoma (SDC) are not clear., Methods: Survival estimates and prognostic factors were evaluated for 228 patients with SDC identified from the Surveillance, Epidemiology, and End Results (SEER) database., Results: Median overall survival (OS) duration for patients with SDC was 79 months and 5-year disease-specific survival (DSS) rate was 64%. Among patients with SDC with lymph node involvement, larger primary tumor size (>3 cm) was associated with twice the risk of death (p < .03). Factors predictive of improved DSS were age (p = .01), tumor size (p = .006), tumor grade (p = .02), and lymph node involvement (p < .001). Adjuvant radiotherapy did not improve survival when compared to surgery alone for early-stage (I-II) disease (p = .28)., Conclusion: Younger patients with SDC (<50 years) showed a better prognosis. Primary tumor size and lymph node involvement were independent and additive risk factors for poor prognosis. The role of adjuvant radiotherapy in the treatment of SDC needs to be explored further., (Copyright © 2013 Wiley Periodicals, Inc.)

The current management of minor salivary gland cancer is reviewed. These malignancies often present as a submucosal swelling and have been reported at all anatomic subsites of the head and neck. Modern imaging is essential in evaluating the location and the anatomic extent of disease. An incisional or punch biopsy determines the histologic type and grade. Recent advances in molecular biology have yielded diagnostic and potential therapeutic targets that may change our treatment in the future. Complete resection is the treatment of choice. Unfortunately, given the proximity of essential structures, the need to balance functional and cosmetic with oncologic consequences can interfere with an adequate "clear margin." The neck should be treated when there is evidence of regional metastasis or when subclinical metastatic risk exceeds 15%. Surgery alone cures most low-stage, low-grade tumors, all other stages and grades require postoperative radiotherapy. Systemic treatment for locoregional and distant failure remains disappointing., (Copyright © 2013 Wiley Periodicals, Inc., A Wiley Company.)

Background: Salivary duct carcinoma (SDC) is an aggressive malignancy with high recurrence rates. Standard management includes surgical resection followed by adjuvant radiation. Androgen receptor positivity has been described to be present in 40% to 90% of SDCs, and a recent case series showed a benefit to androgen deprivation therapy (ADT) in recurrent or metastatic disease., Methods and Results: We present the case of an 87-year-old woman with a locally advanced androgen receptor-positive parotid SDC treated definitively with ADT and external beam radiotherapy, a regimen modeled after the treatment of prostate cancer. She had a complete response on positron emission tomography (PET)/CT scan and had no evidence of disease 24 months after the completion of treatment., Conclusion: To our knowledge, this case report is the first to describe the use of ADT plus radiation to definitively treat SDC. This regimen could be considered in patients with androgen receptor-positive SDCs who are considered unresectable or who refuse surgery., (Copyright © 2013 Wiley Periodicals, Inc.)

Background: In this study we report our preliminary experience with the use of transoral robotic surgery (TORS) for the management of minor salivary gland malignancies of the oropharynx and outcomes., Methods: This was a retrospective review of 10 patients followed over a 5-year period at a single tertiary academic medical center. Patient, tumor, clinicopathologic, functional, and oncologic outcomes were collected and analyzed., Results: All cancers treated were either T1 (40%) or T2 (60%). Negative margins were achieved in all patients. Four patients received adjuvant radiation therapy (40%). No patients experienced surgical complications and all had excellent functional outcomes. Mean follow-up was 24 months (range, 2-60 months) with locoregional and distant control achieved in 8 patients (80%) and 9 patients (90%), respectively., Conclusions: Minor salivary malignancies of the oropharynx are a surgical disease. Short-term follow-up data demonstrate feasibility, low morbidity, good functional, and oncologic results for TORS management of these malignancies., (Copyright © 2013 Wiley Periodicals, Inc.)

Background: We compared clinical outcomes between patients with salivary gland carcinomas preoperatively misdiagnosed as benign lesion and properly diagnosed as malignant lesion., Methods: The outcomes were compared between patients with benign lesion and malignant lesion (44 each) on preoperative fine-needle aspiration cytology diagnosis who underwent conservative or radical surgery., Results: Five-year lesion-free survival (DFS) rates were 86.8% for benign lesion and 76.3% for malignant lesion (p = .128). Surgical extent did not significantly affect locoregional recurrence and DFS (p = .360). Univariate analysis showed that sublingual gland tumor, positive resection margin, and extraparenchymal extension (EPE) were significantly associated with DFS (p < .05 each). On multivariate analysis, EPE remained an independent variable (p = .047, hazard ratio = 6.621, 95% confidence interval = 1.393-31.474)., Conclusions: The clinical outcomes of patients with salivary gland carcinomas misdiagnosed as benign are relatively favorable. Conservative surgery may be sufficient for patients with low-grade and T1-2 salivary gland carcinomas., (Copyright © 2013 Wiley Periodicals, Inc., A Wiley Company.)

Background: Adenoid cystic carcinoma (ACC) of the salivary gland frequently develops lung metastases. In cases in which chemotherapy is indicated, resistance is a common phenomenon. New drugs, such as cetuximab, have been chosen to avoid this chemoresistance., Methods and Results: A 54-year-old man was diagnosed with ACC of the right submandibular gland. He underwent a submandibular gland resection with adjuvant radiotherapy. Three years later, bilateral lung metastases were diagnosed and treated with various chemotherapy schedules, including paclitaxel without success. We obtained radiographic response, followed by disease stabilization for more than 1 year with the addition of cetuximab to paclitaxel administered at low weekly doses (metronomic schedule)., Conclusion: This case demonstrates for the first time a reversion of primary resistance to chemotherapy in ACC that is currently considered chemoresistant by use of a combination of metronomic chemotherapy with new targeted agents such as cetuximab. Metronomic chemotherapy was also well tolerated and achieved long-term response., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: This study was designed to identify the factors associated with the outcome after standard treatment with surgery and postoperative radiotherapy (RT) for locally advanced salivary gland cancers., Methods: We conducted a retrospective review of patients with salivary gland cancers registered in the University of Pittsburgh databases from 1990 to 2006., Results: A total of 74 patients were analyzed. Histologic types included salivary duct carcinoma, 24%; adenoid cystic carcinoma, 23%; and adenocarcinoma, 19%; N2, 39%; N0-1, 58%; and major salivary gland origin, 80%. With a median follow-up of 4.1 years, the 5-year recurrence-free survival (RFS) was 49%, and the 5-year overall survival (OS) was 55%. The 5-year local RFS was 76% and the 5-year distant RFS was 60%. Using Cox-regression analysis, advanced N classification (N2) was the only significant predictor of both RFS and OS., Conclusion: The long-term survival of patients with high-risk, locally advanced salivary gland cancers is unsatisfactory. Advanced nodal disease is strongly associated with patient outcome and should be considered as a stratification factor in future trials in locally advanced salivary gland cancers., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: Tumors of the lateral skull base are best treated with surgery plus or minus radiation therapy. Surgical ablation may involve cutaneous structures, the auricle, the parotid, and the lateral temporal bone. These composite soft tissue defects are best reconstructed with composite tissue. Multiple pedicled flaps have been used to reconstruct these defects. Free flaps have been shown to provide the best tissue for these reconstructions. We review our experience and present an algorithm for their reconstruction., Methods: A case series of consecutive patients treated between 1999 and 2006 at 2 tertiary care institutions, Oregon Health and Science University and University of Alabama at Birmingham were reviewed. There were 73 patients who had periauricular defects requiring 74 free tissue transfers in this retrospective chart review. All defects had extensive cutaneous loss and underwent some form of parotidectomy. There were 57 lateral temporal bone defects and 16 periauricular defects where the external auditory canal was preserved. The majority of patients had nonmelanoma skin malignancies (65%). Eighty percent of patients had undergone previous treatment (radiation therapy, surgery, or a combination therof)., Results: Early on, reconstruction was performed using a radial forearm (RFFF, n=29), evolving to lateral arm (n=6), rectus (n=11), and finally an anterolateral thigh (ALT, n=28) free flap. The average hospital stay was 6 days, and the overall complication rate was 22%. The rectus flap needed debulking in 34% of patients, and the anterolateral thigh in 9%. Periauricular defects were classified based on preservation of the external auditory canal (class I), lateral temporal bone resection with preservation of the auricle (class II), or lateral temporal bone with total auriculectomy (class III)., Conclusion: Class I defects were best managed by RFFF reconstruction, class II defects were managed well with the ALT flap, and class III defects required the ALT or rectus flap.

Background: Our aim was to examine the outcome of patients treated with a planned gamma knife boost after completion of neutron radiotherapy for salivary gland neoplasms involving the base of skull., Methods: Thirty-four patients with salivary gland neoplasms involving the base of skull were treated from 2001 to 2005 at our institution. These results were compared with a similar historical group treated at our institution from 1984 to 2000. The patients had the following characteristics: median age: 54 years (range, 23-80); median follow-up period: 20.5 months (range, 4-55); women-to-men patient ratio: 1.1:1; histology: 29 adenoid cystic, 3 adenocarcinoma, 1 acinic cell, 1 mucoepidermoid; primary sites of disease: 6 nasopharyngeal, 14 paranasal sinuses, 4 parotid gland, 8 oral cavity, 1 lacrimal gland, and 1 auditory canal. All patients had gross residual disease at the time of treatment. The median neutron dose prescribed to isocenter was 19.2 nGy and the median dose to the effected temporal tip was 11.98 nGy. The median prescribed gamma knife dose was 12 Gy to the 50% isodose line. The median number of isocenters was 17. The median target volume treated was 12.4 cm3 (range, 1.9-28.9) with a median total volume treated of 18.3 cm3 (range, 5.9-53.9)., Results: The 24-month and 40-month Kaplan-Meier estimated local control was 82% versus 81% (24 months) and 82% versus 39% (40 months; p = .04) for the gamma knife treated group versus historical controls (n = 61). Two of the 4 failures in the gamma knife-treated group occurred outside the boosted area. Complications were no greater in the gamma knife-treated group than in those treated with neutron radiotherapy alone., Conclusions: Patients with primary salivary gland neoplasms that involve the base of skull and are treated with neutron radiotherapy alone are at high risk of local recurrence. A gamma knife boost improves local control and adds little additional toxicity. These preliminary results suggest that all patients with salivary neoplasms and base of skull invasion should be considered for a gamma knife boost after primary treatment with neutron radiotherapy.

Background: Head and neck tumors are often located near critical organs, making it impossible to deliver a dose of conventional radiotherapy high enough to eradicate the disease. Our aim was to review the potential benefits and available clinical experience of particle beam therapy (hadrontherapy) in the treatment of these tumors., Methods: A review of the literature was carried out through a MEDLINE search (publications between 1980 and 2005)., Results: A review of the available clinical data shows that particle beam therapy can offer several radiobiological and physical advantages over conventional photon radiotherapy: improved dose distribution permits dose escalation within the target and optimal sparing of normal tissue. Preclinical and clinical studies suggest that there may be benefits to using hadrontherapy for tumors characterized by poor radiosensitivity and critical location. At present, the most used hadrons are protons and, as yet on an experimental basis, carbon ions. It is now well accepted that there are certain indications for using proton therapy for skull base tumors (chordoma and chondrosarcoma), paranasal sinus carcinomas, selected nasopharyngeal tumors, and neutron/ion therapy for salivary gland carcinomas (in particular, adenoid cystic tumors). Its viability in other cases, such as locally advanced squamous cell carcinoma, melanoma, soft tissue sarcoma, and bone sarcoma, is still under investigation., Conclusions: Hadrontherapy can be beneficial in the treatment of tumors characterized by poor radiosensitivity and critical location. Further clinical and radiobiological studies are warranted for improved selection of patient population.

Introduction: Pleomorphic adenoma is the most common neoplasm arising in the salivary glands. Surgical management is the primary therapeutic modality. With the use of modern surgical techniques, recurrence is infrequent, and facial nerve sparing is the norm. However, for patients with recurrent disease, the risk of further relapses is increased with surgical resection alone, particularly for those patients in whom multiple recurrences have already occurred. The role of adjuvant radiotherapy in this setting remains uncertain. Although neutron radiotherapy is superior to conventional radiotherapy for malignant salivary gland tumors, its role in the treatment of pleomorphic adenomas is less well defined. We report our experience using this modality for high-risk, recurrent pleomorphic adenomas., Methods: Sixteen patients were treated with neutron radiotherapy for recurrent pleomorphic adenomas of major salivary glands from 1986 through 1993. The median age at diagnosis was 33 years (range, 11-77 years); median age at the time of neutron radiotherapy was 52 years (range, 22-77 years); median number of prior surgical procedures was 3 (range, 1-6); median duration from initial diagnosis to radiotherapy was 14.5 years (range, 3 months-30 years); median follow-up was 83 months (range, 9-144 months). The median period at risk for survivors was 96 months (defined as the interval from completion of neutron radiotherapy to last follow-up). Ten patients had evidence of gross residual disease at the time of treatment as determined by imaging studies, with nine patients having multinodular disease., Results: The 10-year actuarial survival was 79%. One patient died from lung metastases 9 months after treatment; one patient died from a liver tumor of uncertain origin, but the histology could not rule out a metastasis from the previous pleomorphic adenoma; and one patient died from recurrent disease at the base of skull. The 15-year actuarial locoregional control rate was 85%. One of the two patients with locoregional recurrence had a malignant transformation into an adenocarcinoma. No statistical difference in 15-year actuarial survival (75% vs 83%, p =.82) was found comparing patients with gross residual disease vs microscopic residual disease. The actuarial 15-year locoregional control was 76% for patients with gross residual disease vs 100% for those with microscopic disease. The 15-year actuarial risk of RTOG/ESTRO nonaudiologic grade III/IV complications was 21%. No facial nerve injuries were observed as a direct consequence of neutron radiotherapy., Conclusions: Neutron radiotherapy offers both excellent local control rates and survival rates in patients with multiply recurrent pleomorphic adenomas that are not candidates for surgical resection, even in the presence of gross residual disease. The treatment-related morbidity is acceptable. Malignant transformations and metastases, although uncommon, may be observed in this tumor., (Copyright 2001 John Wiley & Sons, Inc.)

Background: Carcinoma ex pleomorphic adenoma (CXPA) is an aggressive, poorly understood salivary gland malignancy. Misdiagnosis is common, because the residual mixed tumor component may be small, and various carcinoma subtypes are possible., Methods: We retrospectively reviewed the medical records of 73 patients with major salivary gland CXPA treated at our institution from 1960 to 1994. Of the 73 patients, 66 had primary tumors and 7 had recurrent tumors; 47 were men, and 26 were women; the mean age was 61 years., Results: Adenocarcinoma (31 cases) and salivary duct carcinoma (24 cases) were the most common malignant subtypes. All patients were treated surgically, and 32 also had radiation therapy. Of 66 patients with primary tumors, 23% had local recurrence. Metastasis (either initial or delayed) occurred regionally in 56% and distantly in 44%. Thirty-six patients (55%) died of the disease. At 3 years, overall survival was 39% and at 5 years, 30%., Conclusions: Important prognostic factors include tumor size, grade, and clinical and pathologic stage. Patients with minimally invasive tumors (<5 mm) should do well with appropriate surgical treatment., (Copyright 2001 John Wiley & Sons, Inc.)

Background: Multiple oral complaints develop during radiation therapy for head and neck cancer, and quality of life is affected after treatment. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms in a cohort of patients during and after radiation therapy., Methods: A general quality of life survey (the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), with an added oral symptom and function scale was administered to a consecutive series of patients who received radiation therapy for head and neck malignant disease. Patients completed surveys at the beginning of radiation therapy, immediately after, and 6 months after treatment., Results and Discussion: The questionnaire used in this study provides increased information regarding the oral and dental function that is frequently affected by radiation therapy. Results of this study indicate the need to determine oral dysfunction after head and neck cancer therapy, so that the most predictable cure or best palliation of the malignancy with the least impact on oral function and quality of life is chosen. Oral complications during and after radiation therapy for head and neck cancer are common and affect quality of life. Oral QOL does not return to pretreatment levels by 6 months after radiation therapy. This study supports the use of a general function scale such as the EORTC questionnaire with the addition of disease/site-specific scales to provide data on outcomes of therapy and on the complications associated with therapy. The EORTC QLQ 30 questionnaire with the oral assessment addendum provides a measure of the quality of life and oral function in head and neck cancer patients and may provide useful outcome measures for assessment of oral care prevention and management strategies in these patient populations. The results show that the questionnaire is responsive to change throughout the course of radiation therapy for head and neck cancer., (Copyright 2001 John Wiley & Sons, Inc.)

Background: Malignant salivary gland tumors are rare tumors of the head and neck region. The treatment of these tumors has generally consisted of surgical extirpation, with postoperative radiotherapy improving locoregional control and survival in patients with high risk tumors. Neutron radiotherapy has been found to be more efficacious than conventional radiotherapy in the setting of inoperable or subtotally resected salivary gland tumors., Methods: One hundred forty-eight patients with malignant salivary tumors of major salivary gland origin were treated at the University of Washington Medical Center with fast neutron radiotherapy between the years 1984 and 1995. One hundred twenty-eight patients were treated with curative intent, and of these, 120 patients had evidence of gross residual disease at the time of treatment. These patients constitute the main analysis of this paper. Of these patients, 19% had recurrent disease, 39% were initially seen with positive lymph nodes, and 11% had previously received full dose conventional radiotherapy. At the time of analysis, the median period at risk of survivors was 26 months., Results: The 5-year actuarial locoregional control rate for all patients with gross tumor treated with curative intent was 59%. A tumor size < or =4 cm was associated with an excellent locoregional control rate (80%), and cause-specific survival (73%) at 5 years compared with patients with larger tumors (35% and 22%, respectively, p<.001 in both cases). On univariate analysis, there appeared to be an advantage in locoregional control for patients with smaller sized tumors (< or =4 cm) who underwent an attempted surgical extirpation. Locoregional control was excellent (100%) in patients having a complete surgical resection of their tumors and undergoing postoperative neutron radiotherapy because of the presence of other high risk factors. Lymph node status at the time of treatment, base of skull involvement, and male sex were associated with the development of distant metastasis, with 52% of node positive patients developing distant metastases by 5 years, compared with 32% of node negative patients (p = .04)., Conclusions: Neutron radiotherapy is an effective form of treatment for patients with high risk, locally advanced tumors of major salivary gland origin. An initial surgical resection appears beneficial in patients for whom such an approach is feasible.

Background: It has been suggested that metastasizing pleomorphic adenomas may represent unrecognized malignancy., Methods: The cytologic and clinical characteristics of two metastasizing pleomorphic adenomas diagnosed by fine-needle sampling are reported., Results: Both showed malignant evolution: the primary tumors arose from the palate and the parotid salivary glands, respectively. Metastases occurred simultaneously with local recurrence in the first patient and after a second local recurrence in the second patient. Both patients were treated by surgery and radiotherapy but died of disseminated disease 8 and 4 years after initial diagnosis. No histologic evidence of malignancy was observed on cytology smears or histology sections in either case., Conclusion: Clinically, our cases support the hypothesis that metastasizing pleomorphic adenomas represent unrecognized malignancy, because the biologic course of two tumors led to unequivocally lethal outcome.

Fourteen cases of adenoid cystic carcinoma (ACC) of the intraoral salivary glands with positive surgical margins have been reviewed in order to determine the role of postoperative radiotherapy in local control. Since local control was obtained in all patients, postoperative radiotherapy seems an adequate treatment to deal with the problem of positive surgical margins at the microscopic level, in cases of intraoral ACC, making additional surgical treatment redundant.